Hollis G. Potter, Orthopedic Radiologist
She may not feel your pain, but chances are she can find out what’s causing it. Hollis G. Potter, chief of magnetic-resonance imaging at the Hospital for Special Surgery, has developed innovative imaging techniques that often uncover conditions that get overlooked by general radiologists, such as cartilage tears in the hip. Her work has led to funding for a state-of-the-art research facility, to open at the hospital this summer.
What sets your technique apart?
Traditionally, X-rays just looked at bones. What MRI has been able to do, and what I have developed, is a way to look at soft tissue, particularly the cartilage, which is absolutely essential for the diagnosis of any orthopedic condition. As a result, we can detect even the most minute tear or fracture as well as get information about the pattern of injury. And for the first time, we can actually look inside a total hip replacement to see if there is any particle-wear disease, from plastic or metal, that eats away at the bone. Putting a big piece of metal into a magnet used to be considered heresy. A lot of places still won’t do it.
How does it work?
Instead of using the standardized large coils, we place smaller ones on the patient to zoom in on elusive soft tissues and bone fragments. Equally important are what are called pulse sequences. I can manipulate those to get different types of diagnostic information.
And the result?
Typically MRIs use a large field of viewfor example, as much as a third of the arm to study a wrist. What we are able to do is to focus on the smallest ligaments. We just see the wrist, not fingertips or forearms or elbows. We can even look at a knuckle. We’ve come up with a whole new way to use MRI for orthopedicsfiguring out which diagnoses we’re consistently missing.
Ever had an MRI?
Before I had research assistants, I was my own guinea pig. As a patient, I would want a radiologist with a measure of expertise in her specialty, not one who jumps from one area of the body to the next. Too many people just go to the most convenient place when they should select a radiologist with the same care they would put into choosing a cardiologist or neurologist.
What do you love most about your work?
Every case is essentially solving a puzzle, and 90 percent of the time, we do. For example, no one has an unexplained joint swelling. It has to be inflammatory or traumatic or infectious. And the answer is always there on the film. You just have to know what to look forand also have that extra spatial resolution and light source. Essentially, I have put new batteries in a dim flashlight.
Richard Barakat, Gynecological Surgeon
The chairman of Memorial Sloan-Kettering’s gynecology department, Richard Barakat specializes in cancer surgeries—from fertility-preserving cervical-cancer procedures to extensive ovarian-cancer removals, like the one taking place during the interview below.
You’re only 43—isn’t that a little young to be head of your surgical division?
What were they thinking? Maybe Doogie Howser. But I’ve been at Memorial Sloan-Kettering for fourteen years, and I’ve been in this division longer than anyone else. Nurse—sweetheart retractor! [Aside] I’m not being fresh with the nurse—this tool really is called the sweetheart retractor.
Tell me about today’s case.
I’m taking out the colon, uterus, and the ovarian-cancer tumor as one mass. Then I’m putting the colon back in and hooking it back up to the rectum. It’ll be a little shorter, but she won’t notice.
What are all those big yellow bumps?
Tumor! You gotta hate it! Look—there’s even a nodule on her appendix. She’ll probably need her spleen out—I can feel a tumor there. But functionally she’s gonna be great. She’ll urinate, she’ll eat. Her bowels and bladder will work. She’ll be like someone who had a hysterectomy.
This isn’t particularly delicate work. You’re really manhandling the organs here.
Yes. And you know, it has to be that way. It’s physically taxing. You have to tug and pull to get this stuff out. It’s a disease that you have to hate. You have to go in with that mind-set.
Are all ovarian-cancer operations this severe?
Most women have advanced cancer by the time they get here, because ovarian cancer is so rarely diagnosed early. But the good news is it’s chemo-sensitive. The more you remove, the better off you are. We call it being “de-bulked.” So we optimally de-bulk everyone here. We do very aggressive work. We cure maybe 35 percent of the women with advanced-stage cancer, but that’s getting better, with so many new drugs to prolong the life span, with long periods of remission.
This surgery will take six hours. Don’t you get exhausted?
I don’t feel it in the OR, but I feel it the next day. So I only do it every other day. Surgery is skilled construction work; it’s a lot of labor. But there’s nothing more satisfying than looking in and seeing such a mess, and when you finish, the patient is clean. You keep saying to yourself, Will she survive? She’s got chemotherapy to go through yet. But at least I’m giving her a fighting chance.
Mordecai Zucker, Family Practitioner
Mordecai Zucker’s patients in the Five Towns and the Rockaways call him “the Angel.” Little wonder. In 50 years of practicing family medicine, he has logged over 45,000 house calls, and he still does three or four a day, year-round. “Illness never takes a holiday,” says Doc, his preferred title.
Why house calls?
I see a lot of patients caught in the limbo of not being sick enough for hospitalization yet not being well enough to get to the office. I want people to know that medical care is still available.
These are mostly elderly patients?
The majority of my patients are over 80. At that age, going to an emergency room is not a real alternative. Because the emergency room works on a triage level, actual emergencies like arterial bleeding or cardiac arrest come first and patients like mine are taken care of last.
Isn’t it true that many tests can only be done in the hospital?
Actually, sophisticated technology—for example, portable X-ray machines and chronic respiratory devices—can now be provided in the home. I myself take a cardiogram on house visits, and either I draw blood or get the lab techs to go.
What does a house call cost these days?
The majority of my patients have Medicare, which allows about $50 for a simple and $80 for a more complicated visit—cheaper for the government, by the way, than an emergency-room visit reimbursed at $125 minimum.
Most unusual house call?
I delivered our neighbor’s baby, something I hadn’t done since getting out of medical school in 1951. It was back in the early seventies, during a monstrous snowstorm that totally shut down the roads. I took a sled to pull her to the hospital, but after a few blocks, with at least a foot and a half of snow, that became impossible. I stopped in front of the home of our rabbi, rang the bell, and asked, “How would you like to have a delivery in your house?” It felt like frontier medicine. We put her in bed and got the sheets ready. “Don’t be afraid,” I told her. “Look around the room and you’ll see I’m the only doctor here, so you have the best doctor in the house.” She delivered a fine baby girl. Then the rabbi, her husband, a neighbor, and I fashioned a stretcher from a day cot and carried her out to the front seat of the only vehicle moving, a sanitation truck, which drove her to the hospital. When her daughter got married twenty years later, I was one of the witnesses.
Harold S. Koplewicz, Child Psychiatrist
Harold S. Koplewicz loves working with children, even if he walks away with some bruises. As vice-chairman of the Department of Psychiatry and professor of clinical psychiatry and pediatrics at NYU, he founded and directs the Child Study Center, which focuses on brain research.
What interested you about this field at first?
When I started my internship in the late seventies, the thing that interested me most was behavioral or emotional problems. Pediatric neurology, though intellectually stimulating, was depressing. There was so little you could do. But psychiatry was about to have a revolution. It was moving toward an understanding that nature had more to do with the problems than nurture. I had previously thought that I could take care of people by being nice to them, like Judd Hirsch in Ordinary People—to save them from cold mothers like Mary Tyler Moore.
What sparked the revolution?
Discoveries in psychopharmacology and the neuroscience of child mental disorders. We can now change and save lives. We can give a child back his childhood.
How pervasive is the problem now?
In 1999, the surgeon general said that 12 percent of the population under 18 had diagnosable psychiatric disorders, and that’s not including addiction. That’s 10 million children, and over each of the last 40 years, about 2,000 teenagers committed suicide. This shouldn’t only matter to parents who have a sick child; you should be concerned about the child sitting next to yours. Look at Columbine.
Is there resistance to treatment?
There are myths that get in the way. One is that it’s the parents’ fault. So they like to hope it’s just a bad phase. Then there’s the myth that we are overmedicating, that kids like to take drugs. But the truth is that most teenagers just want to be like everybody else. No one is having a Prozac party.
Any exciting new breakthroughs?
Our better understanding of the role of the brain in dyslexia and ADD and our knowledge that the brain changes during different stages of development is incredibly important. Turns out that ADD kids have 3 to 4 percent smaller brain volume than normal kids. We also now know that there is a dramatic change in the brain during adolescence, for instance, and that puts teens at a higher risk for depression.
What gives you the most satisfaction?
There is nothing more gratifying than having a kid who tried to bite you come back years later to ask you for advice.
-BETH LANDMAN KEIL
Dr. Carol Levy, Endocrinologist
Physician, heal thyself: Two years ago, this 39-year-old Long Island native left a lucrative Upper East Side practice for New York-Presbyterian Hospital/ Weill Cornell Medical Center, to focus on diabetes, a medical passion that’s equal parts professional and personal.
You had juvenile diabetes, right?
If you get diabetes, you still have it. I was diagnosed when I was 7. It’s a misconception that certain types of diabetes, like juvenile diabetes, are more severe than others. Diabetes is diabetes. You have the same goal, the same risks.
Why did you decide to specialize in diabetes? I was a second-year resident on diabetes rounds, and a patient came running up with a bunch of questions. I was able to answer every single one comfortably—and this was my second year, when you usually don’t feel that comfortable. The patient said things like, “It hurts when I test my blood sugar.” And I said, “Maybe if you use the side of your finger, it won’t hurt so much.” And I thought, Wow, this is a way that I can help people in a different fashion.
How else does your own experience help?
Every so often, I’ll have a very difficult patient who’ll say, “What do you know?! You don’t have diabetes.” And I’ll say, “Well, actually, I’ve had it for 32 years.” Frequently, I’m just using my experience to motivate someone else. Diabetes is more of a self-management disease than anything else. And managing it is about motivation, not just intelligence. I have a lot of patients who aren’t the brightest people in the world who take wonderful care of themselves, and then I have some CEOs who don’t.
Your subspecialty is gestational diabetes, which is only diagnosed during pregnancy. Is that a big issue?
Yes, particularly in New York, where women wait until they’re older to get pregnant.
And you just had your own first child.
That was a very eye-opening experience. I’ve taken care of hundreds of pregnant patients with diabetes. But having been pregnant and realizing how hard it is to manage diabetes, your career, and your home life—I think it makes me a better doctor. You feel like you’re a role model.